Provider Demographics
NPI:1518967488
Name:MONTALVO, RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1541 FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4438
Mailing Address - Country:US
Mailing Address - Phone:209-577-3388
Mailing Address - Fax:209-575-3085
Practice Address - Street 1:1541 FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4438
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-575-3085
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG99015Medicare UPIN